Provider Demographics
NPI:1295857399
Name:BRUCE A DANIELS MD PC
Entity Type:Organization
Organization Name:BRUCE A DANIELS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-636-1166
Mailing Address - Street 1:4221 S WESTERN AVE
Mailing Address - Street 2:SUITE 4045
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3447
Mailing Address - Country:US
Mailing Address - Phone:405-636-1166
Mailing Address - Fax:405-632-8446
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 4045
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-636-1166
Practice Address - Fax:405-632-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10948207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty